Psychotropic drug treatment during pregnancy and lactation : effects on mother and child

The common major depressive disorder and anxiety disorders are often treated with antidepressants. Treatment with mood-stabilizers and antipsychotics are important for pregnant women with bipolar and psychotic disorders, as these women are at risk of postpartum psychosis and even suicide if not treated. The aim of this thesis was to elucidate the risks of psychotropic drug treatment in the perinatal period. Study I aimed at studying sertraline plasma concentrations in pregnant women and their infants and the clinical effects on the infants. Studies II and III focused on antipsychotic treatment during pregnancy and complications for the mother and the infant, respectively. In study IV, we studied infant health and serum lithium concentrations after exposure to lithium through breastmilk. Study I was a part of a randomized controlled trial where women with moderately severe depression in early pregnancy were randomized to treatment with sertraline or placebo together with internet-based cognitive behaviour therapy. Plasma sertraline concentrations were measured in 9 women during and after pregnancy and in 7 of their infants. In study II we extracted data on 1.3 million pregnancies from the Medical Birth Register and the Prescribed Drug Register to study the effects of antipsychotic treatment on pregnancy complications. For study III, these registers were combined with two neonatal quality registers to study the neonatal morbidity in the exposed infants. For study IV, data was extracted retrospectively from the medical records of 30 infant-mother pairs where the infant was exposed to lithium through breastmilk. In study I, the inter-individual variation between the maternal plasma sertraline concentrations measured during pregnancy was tenfold, but the median sertraline concentration was 25-40% lower during pregnancy than postpartum. The medians of the sertraline concentrations measured in cord blood and infant serum at 48 hours of age were 33 and 25% of the median of the maternal concentrations at delivery, and the effects on the infants were mild and transient. In study II, the risk for gestational diabetes was increased after use of olanzapine, quetiapine and clozapine, adjusted risk ratio [RR] 1.8 (95% confidence interval [CI]1.3-2.4). In study III, the 2677 infants exposed to antipsychotics had an increased risk of being admitted to neonatal care, adjusted RR 1.7, (95% CI 1.6-1.8). In study IV, the lithium concentrations in infant serum were low, ≤0.2mmol/l, after one month of age, with the median concentration around 10% of the mothers. In the first month of life, serum lithium concentrations varied more, and two infants had therapeutic lithium concentrations, the highest being 1.2 mmol/l. A third of the infants had poor weight gain in the first month and two were described tired, but no other effects on the infants were found. Psychotropic drug treatment in the peripartal period is associated with some adverse outcomes, but none of the studies in this thesis found any reason to advise against treatment with the included drugs during pregnancy or while breastfeeding. A thorough risk-benefit analysis is required when drug therapy is considered in the peripartal period, as well as increased monitoring of the exposed pregnant women and their infants

Extraoral periapical radiography: an alternative approach to intraoral periapical radiography

It is difficult to take intraoral radiographs in some patients who are intolerable to place the film in their mouth. For these patients, Newman and Friedman recommended a new technique of extraoral film placement. Here we report various cases that diagnostic imaging was performed in patients using the extraoral periapical technique. This technique was used to obtain the radiographs for the patients with severe gag reflex, pediatric dental patients, and patients with restricted mouth opening. This technique can be recommended as an alternative to conventional intraoral periapical technique in cases where intraoral film placement is difficult to achieve

Adiabatic dynamical-decoupling-based control of nuclear spin registers

The use of the nuclear spins surrounding electron spin qubits as quantum registers and long-lived memories opens the way to new applications in quantum information and biological sensing. Hence, there is a need for generic and robust forms of control of the nuclear registers. Although adiabatic gates are widely used in quantum information, they can become too slow to outpace decoherence. Here, we introduce a technique whereby adiabatic gates arise from the dynamical decoupling protocols that simultaneously extend coherence. We illustrate this pulse-based adiabatic control for nuclear spins around NV centers in diamond. We obtain a closed-form expression from Landau-Zener theory and show that it reliably describes the dynamics. By identifying robust Floquet states, we show that the technique enables polarization, one-shot flips, and state storage for nuclear spins. These results introduce a control paradigm that combines dynamical decoupling with adiabatic evolution

Energy development and indigenous Mexican women: An implementation strategy approach in San Jose Villa de Allende, Mexico

Access to safe and sustainable energy is essential for human preservation and improvement of quality of life. Development is not possible without appropriate energy supplies. Arguably the biggest energy challenge of the 21st century is the health and wellbeing of 2.9 billion people globally who rely on burning biomass fuels in traditional stoves. This paper discusses the social and community level impact of using biofuels as an energy source in San Jose Villa de Allende, rural Mexico. Semi structured interviews were undertaken from indigenous women within the village. Picture evidence was also collected in order to identify the major energy problems of the community. The cooking stoves and fuels are identified as being the major contributors to time barriers and health issues for women. An implementation strategy for alternatives chimneys is suggested in order to develop policies for change and mitigate fuel poverty for an increased quality of life for rural Mexican women. The main discussion argues that cultural barriers and traditions are of foremost importance for policy making within the community

The political role of service delivery in state-building: Exploring the relevance of European history for developing countries

Concerns about failed and fragile states have put state- and nation-building firmly on the academic and policy agenda, but the crucial role of public services in this process has remained underexplored. The 1960s and '70s generated a substantial set of literature that is largely missing from current writing. It identified state penetration, standardisation and accommodation as key processes in the state- and nation-building sequence. This article analyses these three processes in Western Europe in the seventeenth to nineteenth centuries, and the role of public services therein, to explore how they may help us to understand the success and failure of state- and nation-building in developing countries and fragile states. © The Authors 2011. Development Policy Revie